Within Syria, the health and humanitarian situation has deteriorated rapidly over the past 2 months. More than 70% of the medical community have fled and most health-care facilities are either damaged or destroyed in opposition areas. Make-shift field hospitals provide essential basic services but lack the necessary equipment and medical supplies to effectively treat the injured and disabled.
The recent Joint Rapid Assessment of Northern Syria found that the overall humanitarian situation has substantially deteriorated in the north. The assessment found that more than 12·9 million people lack access to basic services of food, water, and shelter. The severity and extent of health needs has substantially increased with health and access to health services rated by local populations as the most important and severe problem.
According to WHO, Médecins Sans Frontières (MSF), and field work by the authors, there have been exponential increases in communicable disease outbreaks of measles, typhoid, leishmaniasis, acute diarrhoea, and hepatitis. The combination of rising summer temperatures and poor or absent sanitation poses severe risks for epidemic outbreaks in coming months.
Treatment and services for chronic conditions such as type 2 diabetes, cardiovascular disease, hypertension, chronic obstructive pulmonary disease, and cancer are virtually non-existent in opposition districts. Government-controlled governorates fare little better although they do possess greater access to health-care facilities and medications, and numerous vaccinations campaigns have taken place.
WHO and the US Centers for Disease Control and Prevention (CDC) have established an Early Warning and Disease Surveillance System within government-controlled areas. This system is currently being replicated across the north and in opposition governorates, led by the Assistance Coordination Unit of the National Coalition with technical assistance from the CDC.
Although assistance has increased, it remains insufficient to meet the exponentially growing needs. From our own research, we estimate that more than 250 local NGOs and associations are working within Syria. This is in addition to the international NGOs such as MSF, Médecins du Monde, and the Qatari Red Crescent among others who are operating several field hospitals, mobile clinics, and vaccinations programmes.
The local NGOs' response capacity is a mosaic of associations ranging from American and European Syrian expatriate groups, to wealthy Arab individuals, to Islamic charity organisations from Kuwait, Turkey, and Qatar. They provide services ranging from storage facilities, water supplies to clinics, medical equipment, and food baskets.
However, divisions in response coordination are clearly apparent with many identical projects being duplicated by international and local NGOs. This primarily stems from the lack of trust between both forms of organisation and, in particular, local NGOs are concerned about involvement with UN agencies that work under the guise of the Syrian Government.
Meanwhile, within Lebanon and Jordan, which have received the largest numbers of refugees, the pressure on domestic health systems is immense. In Lebanon, primary and secondary health-care services are available to Syrians but they face large out-of-pocket payments, which are beyond the means of many refugees. UNHCR will only cover a proportion of expenses (75%) for secondary care and provide no coverage for catastrophic illnesses requiring chemotherapy, dialysis, or blood transfusions. These costs have to be met by the individuals themselves or local NGOs.
In Jordan, refugees can freely access health-care services within camps but the hundreds of thousands who live in urban centres face similar fees to those of Jordanians in public hospitals. The strains on the Jordanian health system are apparent with numerous reports of Jordanians being turned away from hospitals because of bed shortages.
According to WHO and the Jordanian Ministry of Health the number of Syrians in public hospitals has increased dramatically by almost 250% over the past 5 months, while those requiring surgical operations outside the refugee camps increased almost 600%.